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Concerns about how much and what kind of care make sense for someone

Ethical issues near the end of life often arise because of concerns about how much and what kind of care make sense for someone with a limited life expectancy, particularly if the patient is very old. In today’s world, advancement in medical science and technology has provided us with devices like respirators, pacemakers, life- saving medicines that have resulted in extending patient’s lives. All of us agree with it, but it has brought many problems with it, like, how to serve those who are alive, but their lives have no better prospects. The moral question arises, whether to help persons who are facing unbearable pain or other sufferings in the terminal stages of their lives to decide for themselves when life is no longer worth living, and to receive assistance in ending their lives, according to the principles of autonomy , self determination and beneficence, preventing unnecessary suffering and preserving their dignity.

The other side of my case talks about the sanctity of life and the moral issue of killing; the possibility of a miracle cure or an incorrect diagnosis; the argument of "slippery slope"; and the aid of modern medicine to control pain.

The Greek word “euthanasia" means “dying in a good way". It is also called “mercy killing".

Kinds of euthanasia 1-3:

Voluntary: The competent patient expressed a wish to die.

Non-voluntary: The patient was incompetent to express a wish to die.

Involuntary Euthanasia: A patient is put to death against his will.

Euthanasia is further broken down into two categories;

Active euthanasia: painlessly putting a person to death ,suffering from incurable disease (for example, by giving a lethal injection).

Passive euthanasia Allowing a patient to die by withholding or withdrawing extraordinary medical care allowing the disease to kill.

The American Medical Association holds that active euthanasia is impermissible, due to it involving the intentional termination of a human life by another human4.

Passive euthanasia is not included in the issue of euthanasia as passive euthanasia refers to the practice of terminating life-sustaining treatments, such as ventilators and artificial nutrition. For centuries these practices have been considered ethical and legal. The pain relief and comfort by administering benzodiazepines, opiates or other interventions is considered ethical, despite the fact that they increase the risk of death. Use of morphine for pain relief in terminally ill patients is allowed even if the patient’s death results from respiratory depression.

Physician Assisted Suicide (PAS): The physician provides an individual with the information, prescription, guidance, and means to take his or her own life with the intention that they will be used for this purpose.

Arguments for Euthanasia

1: An entity can’t be considered a person, for example, in case of irreversible coma or brain death. For, he must possess certain psychosocial factors like consciousness, self-consciousness, rationality and the capacities for communication and moral judgment. (Personhood).So there is nothing objectionable to allow or cause a person to die.

2: In the case of the terminally ill, life sustaining treatments erode their dignity, destroy their self concept and self respect and reduce them to sub-human level.

3: Individual’s autonomy justifies euthanasia. A person's right to well-being includes the right

not to suffer physically or psychologically

to know their medical condition

to choose or to reject the medical treatment regimen

To choose or to reject the efforts to prolong their life.

4: Beneficence that is, furthering the well being of individuals. When living creates more pain and suffering, ending a painful life will actually produce more good. The option of euthanasia can provide psychological reassurance.

In his account of Euthanasia, moral philosopher James Rachel mentions that there is no moral difference between active and passive euthanasia1. Rachels view is that active euthanasia can be morally preferable option, as the process of being" allowed to die “can be relatively slow and painful, while giving a lethal injection is relatively quick and painless.

5: Permitting euthanasia or PAS will not undermine the physician-patient relationship as it is done on the basis of consent.

Arguments against permitting euthanasia and/or PAS

1: If an entity is determined to be a nonperson, a death decision cannot necessarily follow, even when the law sanctions brain death criteria, it does not compel health professionals to implement it.

2: Nothing could be more dignified than to maintain life against all odds, against all hopes. Sometimes will power and determination lead to miracles.

3: Autonomy does not justify euthanasia and/or PAS. A dying patient, using freedom is to eliminate freedom in the form of death, thus eliminating all future meaningful options. Exercising autonomy would mean ending the possibility of exercising autonomy.

4: The principle of beneficence does not necessarily mean that euthanasia and/or PAS are the only means of improving well being. If quality care is given to sick, needless pain and suffering can be avoided .Adequate care relieves most pain and sufferings.

Professor of philosophy Philippa Foot writes that if someone would be better off dead, if that person wants to live, we are not justified in killing him.1

Murder is an action by a person to end another human’s life. Using this logic, there is no moral difference between murder and performing active euthanasia (even for mercy sake).

There are potential adverse consequences of permitting euthanasia and/or PAS. It may lead to involuntary euthanasia. The terminally ill patients often see themselves as social, economic, and emotional burdens to others and in their debilitated condition( often an act of desperation )listen to suggestion - such as relatives and doctor's agreeing that they are a burden(Slippery slope)

5: Legalizing euthanasia or PAS may lead to law suits, thus affecting the physician-patient relationship.

Legal status5

Active euthanasia is not legal. PAS is legal in the Netherlands, Belgium, and Switzerland. In the United States, Oregon legalized PAS in 1997, and the practice was legalized in Washington State in March of 2009.

Handling Requests for Euthanasia

1: Listen to the person's request and affirm that you understand that a great deal of suffering underlies the request. Being heard and affirmed can remedy some of the major sources of psychosocial suffering that tend to accompany such requests.

2: Avoid taking a moral stance. A principled stance against the act can make the person who has just requested euthanasia or PAS feel judged, which may add to his or her suffering. A principled stance for the act risks inadvertently compounding the person's sense of worthlessness and conviction that they would be better off dead.

3: Conduct a comprehensive assessment to understand the nature and sources of the entire patient's physical, psychological, spiritual and social suffering. Physicians should determine what social relationships and supports the patient has, and encourage interactions with family and others. Reassurance should be provided if one of the patient's concerns is that the physician will not be available or might abandon them.

4: Address each of those sources of suffering with the full armamentarium of palliative care strategies. Most pain and other physical causes of suffering can be reduced to acceptable levels. Much of the depression, anxiety and other psychological suffering can be minimized. Spiritual suffering can be addressed, as can social issues. With skilled use of palliative care, most experts find that a great majority of cases are resolved and the request goes away. Consulting a specialist in palliative care may well be necessary for difficult cases.

5: For cases that do not resolve even with these measures, make sure that other measures that are less morally controversial have also been discussed. As examples : (a) Withholding nutrition and hydration at a point that they have become medically contraindicated, (b) Terminal sedation, in which a person is sedated for lack of available alternatives to control suffering, knowing that such a state cannot be improved on until death, is also accepted as morally correct. (c) Withdrawal of unwanted life-sustaining interventions, with medical management for comfort, is also accepted as morally correct. (d) Stitching off ventilator on the request of an individual who has clear understanding and full capacity and declines continued support on a ventilator

6: Consult with colleagues, palliative care experts, social workers and ethics committee. Decisions about life and death matters should never be made in isolation.

Requests can persist despite efforts at good end of life care. The patient must be told, as gently as possible, without taking a moral stance, that the practice is illegal.

Euthanasia and Islam6

Islam is against active euthanasia. Human life is given by Allah, therefore it is sacred and only Allah chooses how long each person will live. Human beings should not interfere in this. Euthanasia and suicide are not included among the reasons allowed for killing in Islam.

Holy Quran states

Do not take life, which Allah made sacred, other than in the course of justice (Quran 17:33)

Destroy not yourselves. Surely Allah is ever merciful to you (Quran 4:29)

And no person can ever die except by Allah's leave and at an appointed term (Quran 3:145).

Euthanasia is forbidden in Islam because killing is a major sin. However, the with drawl of medical treatment is permissible. The majority of Muslim scholars consider medical treatment of an illness as non-obligatory but permissible. However, few scholars maintain that it is obligatory.

Euthanasia & moral philosophies

1. Duty to oneself

Suicide is wrong according to Immanuel Kant, because we thereby violate a duty to our self. The extension of this maxim applies to euthanasia. Kant explains that if a person’s life is completely destroyed by disease and has become a burden, when life has taken away all the relish and hope, but the person being strong minded, preserves his life without loving it, not from inclination but from duty, only then his maxim has a moral worth.7

Conclusion

The ethics of medical profession bar a physician from any intention to kill a patient or to help him in killing himself. The sanctity of life, maintains that there are no circumstances under which it is right to choose death for oneself or to take the life of innocent others. Two fundamental moral values: that of providing care for those in need and refraining from harming them, much less taking their lives, enjoins health professionals to honor both of these values. The medical treatment should never be at war with moral treatment. Therefore, I conclude that legalizing any form of euthanasia will not in any way deal with the needs of patients at the end of life as no society has yet worked out the issue of how to help those patients who desire to die, without endangering all the institutions.. We must try to give quality care to the dying patients and make them as comfortable as possible. Even for a good motive, the taking of life, is an action which will challenge our humanity.

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